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Grosse SD, Fleming P, Pesch MH, Rawlinson WD. Estimates of congenital cytomegalovirus-attributable infant mortality in high-income countries: A review. Rev Med Virol 2024; 34:e2502. [PMID: 38282398 PMCID: PMC10878676 DOI: 10.1002/rmv.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/15/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024]
Abstract
As many as 5%-10% of infants with symptomatic congenital cytomegalovirus (cCMV) disease, or 0.4%-0.8% of all liveborn infants with cCMV infection, die in early infancy in high-income countries. However, estimates are uncertain due to several potential biases that can result from data limitations and study designs. First, infants with cCMV infections who die prior to diagnosis, which usually occurs at 1-4 weeks after birth, may be excluded from both the count of deaths and the denominator of cCMV births, resulting in left truncation and immortal time biases. These 'biases' are features of the data and do not reflect bias on the part of researchers, but understanding the potential existence of threats to validity can help with interpretation of findings. Left truncation of infant deaths occurring prior to diagnosis of cCMV can result in understatement of the burden of infant deaths due to cCMV. Conversely, overestimation of infant deaths associated with symptomatic cCMV may occur in clinical case series owing to greater representation of relatively severely affected infants owing to ascertainment and referral biases. In this review, we summarise the characteristics of 26 studies that reported estimates of cCMV-associated infant deaths, including potential biases or limitations to which those estimates may have been subject. We discuss study designs whose implementation might generate improved estimates of infant deaths attributable to cCMV. More complete estimates of the overall public health impact of cCMV could inform current and future screening, prevention, and vaccine research.
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Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Patrick Fleming
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut, USA
| | - Megan H. Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - William D. Rawlinson
- Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Sydney, New South Wales, Australia
- School of Biomedical Sciences & School of Biotechnology and Biomolecular Sciences, University of New South Wales, Sydney, New South Wales, Australia
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2
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Boppana SB, van Boven M, Britt WJ, Gantt S, Griffiths PD, Grosse SD, Hyde TB, Lanzieri TM, Mussi-Pinhata MM, Pallas SE, Pinninti SG, Rawlinson WD, Ross SA, Vossen ACTM, Fowler KB. Vaccine value profile for cytomegalovirus. Vaccine 2023; 41 Suppl 2:S53-S75. [PMID: 37806805 DOI: 10.1016/j.vaccine.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 10/10/2023]
Abstract
Cytomegalovirus (CMV) is the most common infectious cause of congenital malformation and a leading cause of developmental disabilities such as sensorineural hearing loss (SNHL), motor and cognitive deficits. The significant disease burden from congenital CMV infection (cCMV) led the US National Institute of Medicine to rank CMV vaccine development as the highest priority. An average of 6.7/1000 live births are affected by cCMV, but the prevalence varies across and within countries. In contrast to other congenital infections such as rubella and toxoplasmosis, the prevalence of cCMV increases with CMV seroprevalence rates in the population. The true global burden of cCMV disease is likely underestimated because most infected infants (85-90 %) have asymptomatic infection and are not identified. However, about 7-11 % of those with asymptomatic infection will develop SNHL throughout early childhood. Although no licensed CMV vaccine exists, several candidate vaccines are in development, including one currently in phase 3 trials. Licensure of one or more vaccine candidates is feasible within the next five years. Various models of CMV vaccine strategies employing different target populations have shown to provide substantial benefit in reducing cCMV. Although CMV can cause end-organ disease with significant morbidity and mortality in immunocompromised individuals, the focus of this vaccine value profile (VVP) is on preventing or reducing the cCMV disease burden. This CMV VVP provides a high-level, comprehensive assessment of the currently available data to inform the potential public health, economic, and societal value of CMV vaccines. The CMV VVP was developed by a working group of subject matter experts from academia, public health groups, policy organizations, and non-profit organizations. All contributors have extensive expertise on various elements of the CMV VVP and have described the state of knowledge and identified the current gaps. The VVP was developed using only existing and publicly available information.
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Affiliation(s)
- Suresh B Boppana
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Michiel van Boven
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, and Julius Center for Health Sciences and Primary Care, Department of Epidemiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - William J Britt
- Departments of Pediatrics, Microbiology, and Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, USA
| | - Soren Gantt
- Centre de recherche du CHU Sainte-Justine, Montréal, QC H3T 1C5, Canada
| | - Paul D Griffiths
- Emeritus Professor of Virology, University College London, United Kingdom
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Terri B Hyde
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tatiana M Lanzieri
- Measles, Rubella, and Cytomegalovirus Epidemiology Team, Viral Vaccine Preventable Diseases Branch / Division of Viral Diseases. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Sarah E Pallas
- Global Immunization Division, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329-4027, USA
| | - Swetha G Pinninti
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William D Rawlinson
- Serology and Virology Division, NSW Health Pathology Randwick, Prince of Wales Hospital, Sydney, Australia; School of Biotechnology and Biomolecular Sciences, and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Shannon A Ross
- Departments of Pediatrics and Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Karen B Fowler
- Departments of Pediatrics and Epidemiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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3
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Yin MZ, Gu YY, Shu JT, Zhang B, Su M, Zhang LP, Jiang YH, Qin G. Cost-effectiveness of cytomegalovirus vaccination for females in China: A decision-analytical Markov study. Vaccine 2023; 41:5825-5833. [PMID: 37580210 DOI: 10.1016/j.vaccine.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The global burden of disease caused by congenital cytomegalovirus (CMV) infection is high. Previous modeling studies have suggested that CMV vaccination may be cost-effective in developed countries. Congenital CMV infection is more likely driven by maternal non-primary infection in China. We aimed to measure the effectiveness and cost-effectiveness of population-level CMV vaccination in Chinese females. METHODS A decision tree Markov model was developed to simulate potential CMV vaccination strategies in a multi-cohort setting, with a population size of 1,000,000 each for the infant, adolescent (10-year-old) and young adult (20-year-old) cohorts. The hypothetical vaccines were assumed to have 50% efficacy, 20 years of protection, 70% coverage, at a price of US$120/dose for base-case analysis. Costs and disability-adjusted life years (DALYs) were discounted by 3% per year and the vaccination would be considered cost-effective if an incremental cost-effectiveness ratio (ICER) was lower than 2021 Chinese per capita GDP (US$12,500). FINDINGS For the pre-infection (PRI) vaccine efficacy type, the adolescent strategy was the most cost-effective, with an ICER of US$12,213 (12,134 to 12,291) pre DALY averted, compared with the next best strategy (young adult strategy). For pre- and post-infection (P&PI) efficacy type, the young adult strategy was the most cost-effective as it was cost-saving. In one-way analysis varying the PRI vaccine price, the infant strategy, adolescent strategy and the young adult strategy would be a dominant strategy over others if the vaccine cost ≤US$60, US$61-121 and US$122-251 per dose respectively. In contrast, the young adult strategy continued to be the preferred strategy until the P&PI vaccine price exceeded US$226/dose. Our main results were robust under a wide variety of sensitivity analyses and scenario analyses. INTERPRETATION CMV vaccination for females would be cost-effective and even cost-saving in China. Our findings had public health implications for control of CMV diseases.
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Affiliation(s)
- Meng-Zhao Yin
- Department of Infectious Diseases, Affiliated Hospital of Nantong University, Nantong, JS, China
| | - Yuan-Yuan Gu
- Centre for the Health Economy, Macquarie University, Sydney, NSW, Australia
| | - Jun-Tao Shu
- Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong, JS, China
| | - Bin Zhang
- Department of Infectious Diseases, Affiliated Hospital of Nantong University, Nantong, JS, China
| | - Min Su
- Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, JS, China
| | - Lu-Ping Zhang
- Department of Otolaryngology, Affiliated Hospital of Nantong University, Nantong, JS, China.
| | - Yin-Hua Jiang
- Clinical Medicine Research Center, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, JS, China.
| | - Gang Qin
- Department of Infectious Diseases, Affiliated Hospital of Nantong University, Nantong, JS, China; Department of Epidemiology and Biostatistics, School of Public Health, Nantong University, Nantong, JS, China.
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Diaz-Decaro J, Myers E, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Schmidt E, Natenshon A, Talarico C, Buck PO. A systematic literature review of the economic and healthcare resource burden of cytomegalovirus. Curr Med Res Opin 2023; 39:973-986. [PMID: 37395088 DOI: 10.1080/03007995.2023.2222583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) can infect individuals at any age, including infants, who may contract it from infected mothers (congenital CMV [cCMV]). Whereas CMV infection is typically asymptomatic or causes mild illness in healthy individuals, infection can result in severe outcomes in immunocompromised individuals and in infants with cCMV. This systematic review aims to characterize the economic impact of CMV and cCMV infections. METHODS Medline, Embase, and LILACS databases were searched for publications reporting the economic impact of cCMV and CMV infections across all age groups. Manuscripts published between 2010 and 2020 from Australia, Latin America, Canada, Europe, Israel, Japan, the United States, and global (international, worldwide) studies were included; congress materials were excluded. Outcomes of interest included cCMV- and CMV-attributable direct costs/charges, resource utilization, and indirect/societal costs. RESULTS Of 751 records identified, 518 were excluded based on duplication, population, outcome, study design, or country. Overall, 55 articles were eligible for full-text review; 25 were further excluded due to population, outcome, study design, or congress abstract. Two publications were additionally identified, resulting in economic impact data compiled from 32 publications. Of these, 24 publications reported cost studies of cCMV or CMV, including evaluation of direct costs/charges, healthcare resource utilization, and indirect/societal costs, and 7 publications reported economic evaluations of interventions. The populations, methods and outcomes used across these studies varied widely. CONCLUSIONS CMV and cCMV infections impose a considerable economic impact on different countries, populations, and outcomes. There are substantial evidence gaps where further research is warranted.
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Affiliation(s)
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
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5
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Moseley P, Klenerman P, Kadambari S. Indirect effects of cytomegalovirus infection: Implications for vaccine development. Rev Med Virol 2023; 33:e2405. [PMID: 36378563 PMCID: PMC10078107 DOI: 10.1002/rmv.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/12/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
Development of a cytomegalovirus (CMV) vaccine is a high priority due to its significant global impact-contributing to mortality in immunosuppressed individuals, neurodevelopmental delay in infected neonates and non-genetic sensorineural hearing loss. The impact of CMV on the general population has been less well studied; however, a wide range of evidence indicates that CMV may increase the risk of atherosclerosis, cancer, immunosenescence, and progression of tuberculosis (TB) and human immunodeficiency virus. Due to the high seroprevalence of CMV worldwide, any modulation of risk by CMV is likely to have a significant impact on the epidemiology of these diseases. This review will evaluate how CMV may cause morbidity and mortality outside of the neonatal and immunosuppressed populations and consider the potential impact of a CMV vaccine on these outcomes.
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Affiliation(s)
- Philip Moseley
- Department of Paediatrics, Horton General Hospital, Oxford University Hospitals, Banbury, UK
| | - Paul Klenerman
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Seilesh Kadambari
- Department of Paediatrics, Oxford Vaccine Group, University of Oxford, Oxford, UK.,NIHR Oxford Biomedical Research Centre, Oxford, UK.,Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Great Ormond Street Institute of Child Health, University College London, London, UK
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6
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Fisher SA, Miller ES, Yee LM, Grobman WA, Premkumar A. Universal First-Trimester Cytomegalovirus Screening and Valaciclovir Prophylaxis in Pregnant Persons: A Cost-Effectiveness Analysis. Am J Obstet Gynecol MFM 2022; 4:100676. [PMID: 35714861 DOI: 10.1016/j.ajogmf.2022.100676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent studies suggest a possible benefit of valaciclovir prophylaxis to prevent vertical transmission after a positive serologic screen for primary maternal cytomegalovirus infection during pregnancy, although its cost-effectiveness remains uncertain. OBJECTIVE We sought to determine the circumstances under which universal first-trimester maternal serologic screening for maternal cytomegalovirus infection, with valaciclovir prophylaxis to prevent congenital cytomegalovirus, is cost-effective. STUDY DESIGN We performed a decision analysis from the perspective of the pregnant person to assess whether universal maternal screening in the first trimester, with subsequent valaciclovir prophylaxis (8g/day from time of positive serologic screen for primary maternal cytomegalovirus infection through 21 weeks' gestation) for those who are acutely infected, is cost-effective compared to usual care (i.e., no routine serologic screening, but amniocentesis if mid-trimester sonographic findings suggest cytomegalovirus). For baseline estimates, we assumed a 35% risk of congenital cytomegalovirus after primary maternal infection and a 71% risk reduction with valaciclovir. We varied valaciclovir's efficacy to identify whether and at what threshold universal screening would be estimated to be cost-effective, compared to usual care. Monte Carlo analyses were performed. A willingness-to-pay threshold of $100,000/quality-adjusted life year was used to define cost-effectiveness. RESULTS Under base-case estimates, first-trimester universal screening and valaciclovir prophylaxis for seropositive pregnant persons with acute cytomegalovirus infection is not cost-effective, with a cost of $137,854 per maternal QALY, but results in 14 fewer cytomegalovirus-affected children per 100,000 pregnancies compared to usual care. In one-way sensitivity analysis, universal screening and treatment is estimated to be the cost-effective strategy if the incidence of primary maternal cytomegalovirus infection exceeds 2.6%, baseline risk of vertical transmission of cytomegalovirus without prophylaxis is greater than 36.8%, and the risk reduction of vertical transmission of cytomegalovirus with valaciclovir prophylaxis exceeds 75.9%. In Monte Carlo analyses, first-trimester universal serologic screening with valaciclovir prophylaxis is estimated to be the cost-effective strategy in 46.8% of runs. CONCLUSION Universal first-trimester serologic screening with valaciclovir prophylaxis is not the cost-effective strategy for antenatal management of cytomegalovirus under the base-case estimates. Although universal screening is cost-effective in certain circumstances when the efficacy of valaciclovir exceeds the base case, that result is not robust to variation of estimates across their reasonable ranges. These data can inform future studies to evaluate screening and treatment to prevent congenital CMV.
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Affiliation(s)
- Stephanie A Fisher
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - William A Grobman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The Ohio State University College of Medicine, Cleveland, Ohio.
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
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7
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Prevention of Congenital Cytomegalovirus Infection with Vaccines: State of the Art. Vaccines (Basel) 2021; 9:vaccines9050523. [PMID: 34069321 PMCID: PMC8158681 DOI: 10.3390/vaccines9050523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
Cytomegalovirus (CMV) is the most common cause of congenital infection and non-genetic sensorineural hearing loss in childhood. Up to 2% of neonates, with the highest percentages found in developing countries, are congenitally infected with CMV. At birth, most of these infants are asymptomatic. However, approximately 10% have signs and symptoms of the disease, and 40–60% of symptomatic neonates will later develop permanent neurologic sequelae. To reduce congenital CMV (cCMV) infection, a vaccine able to prevent primary infection is essential. In this narrative review, actual ongoing research about the development of a CMV vaccine is discussed. The progressive increase in knowledge on the ways in which the host’s immune system and CMV relate has made it possible to clarify that the development of a vaccine that is certainly capable of reducing the risk of cCMV infection, and preventing both primary and nonprimary infections is extremely difficult. Many of the ways in which the virus evades the immune system and causes cCMV infection are not yet fully understood, especially in cases of nonprimary infection. Moreover, the schedule that should be recommended and that subjects must be vaccinated to obtain the greatest effect have not been precisely defined. Further studies are needed before the problem of cCMV infection and its related challenges can be totally solved.
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Borre ED, Diab MM, Ayer A, Zhang G, Emmett SD, Tucci DL, Wilson BS, Kaalund K, Ogbuoji O, Sanders GD. Evidence gaps in economic analyses of hearing healthcare: A systematic review. EClinicalMedicine 2021; 35:100872. [PMID: 34027332 PMCID: PMC8129894 DOI: 10.1016/j.eclinm.2021.100872] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Hearing loss is a common and costly medical condition. This systematic review sought to identify evidence gaps in published model-based economic analyses addressing hearing loss to inform model development for an ongoing Lancet Commission. METHODS We searched the published literature through 14 June 2020 and our inclusion criteria included decision model-based cost-effectiveness analyses that addressed diagnosis, treatment, or prevention of hearing loss. Two investigators screened articles for inclusion at the title, abstract, and full-text levels. Data were abstracted and the studies were assessed for the qualities of model structure, data assumptions, and reporting using a previously published quality scale. FINDINGS Of 1437 articles identified by our search, 117 unique studies met the inclusion criteria. Most of these model-based analyses were set in high-income countries (n = 96, 82%). The evaluated interventions were hearing screening (n = 35, 30%), cochlear implantation (n = 34, 29%), hearing aid use (n = 28, 24%), vaccination (n = 22, 19%), and other interventions (n = 29, 25%); some studies included multiple interventions. Eighty-six studies reported the main outcome in quality-adjusted or disability-adjusted life-years, 24 of which derived their own utility values. The majority of the studies used decision tree (n = 72, 62%) or Markov (n = 41, 35%) models. Forty-one studies (35%) incorporated indirect economic effects. The median quality rating was 92/100 (IQR:72-100). INTERPRETATION The review identified a large body of literature exploring the economic efficiency of hearing healthcare interventions. However, gaps in evidence remain in evaluation of hearing healthcare in low- and middle-income countries, as well as in investigating interventions across the lifespan. Additionally, considerable uncertainty remains around productivity benefits of hearing healthcare interventions as well as utility values for hearing-assisted health states. Future economic evaluations could address these limitations. FUNDING NCATS 3UL1-TR002553-03S3.
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Affiliation(s)
- Ethan D. Borre
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Mohamed M. Diab
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Austin Ayer
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Gloria Zhang
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Susan D. Emmett
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Debara L. Tucci
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD, United States
| | - Blake S. Wilson
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
- Department of Electrical & Computer Engineering, Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Kamaria Kaalund
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Osondu Ogbuoji
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham NC, United States
| | - Gillian D. Sanders
- Department of Medicine, Duke University School of Medicine, Durham, NC, United States
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Duke University Clinical Research Institute, Duke University School of Medicine, Durham NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, United States
- Corresponding author at: Gillian Sanders Schmidler, PhD, Duke-Robert J. Margolis, MD, Center for Health Policy, 100 Fuqua Drive, Box 90120, Durham, NC 27708-0120.
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9
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Monetary Valuation of Children's Cognitive Outcomes in Economic Evaluations from a Societal Perspective: A Review. CHILDREN-BASEL 2021; 8:children8050352. [PMID: 33946651 PMCID: PMC8146900 DOI: 10.3390/children8050352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 01/12/2023]
Abstract
Cognitive ability in childhood is positively associated with economic productivity in adulthood. Expected gains in economic output from interventions that protect cognitive function can be incorporated in benefit-cost and cost-effectiveness analyses conducted from a societal perspective. This review summarizes estimates from high-income countries of the association of general cognitive ability, standardized as intelligence quotient (IQ), with annual and lifetime earnings among adults. Estimates of the association of adult earnings with cognitive ability assessed in childhood or adolescence vary from 0.5% to 2.5% per IQ point. That range reflects differences in data sources and analytic methods. We take a conservative published estimate of a 1.4% difference in market productivity per IQ point in the United States from a recent study that controlled for confounding by family background and behavioral attributes. Using that estimate and the present value of lifetime earnings calculated using a 3% discount rate, the implied lifetime monetary valuation of an IQ point in the United States is USD 10,600-13,100. Despite uncertainty and the exclusion of non-market productivity, incorporation of such estimates could lead to a fuller assessment of the benefits of public health and clinical interventions that protect the developing brains of fetuses, infants, and young children.
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10
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Xia W, Yan H, Zhang Y, Wang C, Gao W, Lv C, Wang W, Liu Z. Congenital Human Cytomegalovirus Infection Inducing Sensorineural Hearing Loss. Front Microbiol 2021; 12:649690. [PMID: 33936007 PMCID: PMC8079719 DOI: 10.3389/fmicb.2021.649690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Human cytomegalovirus (HCMV) is the primary cause of congenital infections. Despite its clinical significance, congenital HCMV infection is frequently overlooked clinically since most affected infants are asymptomatic. Sensorineural hearing loss (SNHL) is one of the most widely known disorders caused by congenital HCMV infection. The potential mechanism, however, remains unknown to date. The mechanism by which congenital HCMV infection induces sensorineural deafness has been partly characterized, leading to advancements in diagnosis, therapy, and prevention strategies. HCMV-induced hearing loss primarily involves immune responses, the release of inflammatory factors by natural killer (NK) cells, apoptosis of cochlear spiral ganglion, and potential changes due to vascular dysfunction. The diagnosis of HCMV induced SNHL includes serological examination to mothers, imaging, and amniotic fluid examination. Ganciclovir, mainly used for antiviral therapy and behavioral prevention, can, to some degree, prevent congenital HCMV infection. The role of HCMV infection in hearing loss needs further investigation since the mechanism of hearing loss caused by cytomegalovirus infection is not well understood. Although some advancement has been made in diagnosing and treating SNHL, more improvement is needed. A comprehensive understanding of cytomegalovirus’s pathogenesis is of key importance for preventing, diagnosing, and treating SNHL.
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Affiliation(s)
- Wenwen Xia
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Hui Yan
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yiyuan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Congcong Wang
- Department of Microbiology, Weifang Medical University, Weifang, China
| | - Wei Gao
- Key Lab for Immunology in Universities of Shandong Province, School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Changning Lv
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Wentao Wang
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Zhijun Liu
- Department of Microbiology, Weifang Medical University, Weifang, China
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11
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Grosse SD, Dollard SC, Ortega-Sanchez IR. Economic assessments of the burden of congenital cytomegalovirus infection and the cost-effectiveness of prevention strategies. Semin Perinatol 2021; 45:151393. [PMID: 33551180 PMCID: PMC8335728 DOI: 10.1016/j.semperi.2021.151393] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This is a critical review of published economic analyses on congenital cytomegalovirus infection and strategies for its detection and prevention. FINDINGS The review identified four cost-of-illness studies and nine cost-effectiveness analyses: three of vaccination of young women, two of prenatal screening, and four of newborn screening. All reported either large economic costs or favorable cost-effectiveness of interventions. However, sensitivity analyses did not address some of the most critical assumptions. CONCLUSIONS Reviewed economic analyses overattributed certain adverse long-term outcomes to congenital cytomegalovirus infection, while other long-term costs were not included. Overall, limited conceptual frameworks, unrepresentative data sources, and unsupported or inadequately documented assumptions regarding outcomes and costs hinder the ability of policymakers to draw conclusions. A major challenge is the limited information on long-term outcomes and costs for representative cohorts of individuals with congenital cytomegalovirus, which further research could helpfully address.
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Affiliation(s)
- Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,Corresponding author. (S.D. Grosse)
| | - Sheila C. Dollard
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ismael R. Ortega-Sanchez
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Mabilangan C, Burton C, O’Brien S, Plitt S, Eurich D, Preiksaitis J. Using blood donors and solid organ transplant donors and recipients to estimate the seroprevalence of cytomegalovirus and Epstein-Barr virus in Canada: A cross-sectional study. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:158-176. [PMID: 36341316 PMCID: PMC9608736 DOI: 10.3138/jammi-2020-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/03/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are common, causing significant morbidity in pregnancy (congenital CMV) and transplant recipients (CMV, EBV). Canadian prevalence data are needed to model disease burden and develop strategies for future vaccines. We estimated prevalence using screening data from blood donors and solid organ transplant (SOT) donors and recipients. METHODS We retrospectively analyzed CMV and EBV serology from Alberta SOT donors (n = 3,016) and recipients (n = 4,614) (1984-2013) and Canadian Blood Services blood donors (n = 1,253,350) (2005-2014), studying associations with age, sex, organ, year, and geographic region. RESULTS CMV seroprevalence rises gradually with age. By age 70, CMV seropositivity ranged from 67% (blood donors) to 73% (SOT recipients). Significant proportions of women of child-bearing age were CMV-seronegative (organ donors, 44%; SOT recipients, 43%; blood donors, 61%). Blood donor CMV seroprevalence decreased from 48% in Western Canada to 30% in Eastern Canada. Women were more likely to be CMV-seropositive (ORs = 1.58, 1.45, and 1.11 for organ donors, SOT recipients, and blood donors, respectively) and EBV-seropositive (ORs = 1.87 and 1.46 for organ donors and SOT recipients, respectively). EBV prevalence rises rapidly, and by age 17-29 years, 81% of SOT recipients and 90% of organ donors were seropositive. CONCLUSIONS Canada has relatively low and perhaps decreasing age-specific EBV and CMV prevalence, making Canadians vulnerable to primary infection-associated morbidity and suggesting benefit from future vaccines. Collection and analysis of routine serology screening data are useful for observing trends.
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Affiliation(s)
- Curtis Mabilangan
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Burton
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Sheila O’Brien
- Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sabrina Plitt
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Dean Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jutta Preiksaitis
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
- Correspondence: Jutta Preiksaitis, Division of Infectious Diseases, Department of Medicine, 1-125 CSB, 11350 83 Avenue, Edmonton, Alberta T6G 2G3, Canada. Telephone: 780-492-8164. Fax: 780-492-8050. E-mail:
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Rozhnova G, E Kretzschmar M, van der Klis F, van Baarle D, Korndewal M, C Vossen A, van Boven M. Short- and long-term impact of vaccination against cytomegalovirus: a modeling study. BMC Med 2020; 18:174. [PMID: 32611419 PMCID: PMC7331215 DOI: 10.1186/s12916-020-01629-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Infection with cytomegalovirus (CMV) is highly prevalent worldwide and can cause severe disease in immunocompromised persons and congenitally infected infants. The disease burden caused by congenital CMV infection is high, especially in resource-limited countries. Vaccines are currently under development for various target groups. METHODS We evaluated the impact of vaccination strategies and hygiene intervention using transmission models. Model parameters were estimated from a cross-sectional serological population study (n=5179) and a retrospective birth cohort (n=31,484), providing information on the age- and sex-specific CMV prevalence and on the birth prevalence of congenital CMV (cCMV). RESULTS The analyses show that vertical transmission and infectious reactivation are the main drivers of transmission. Vaccination strategies aimed at reducing transmission from mother to child (vaccinating pregnant women or women of reproductive age) can yield substantial reductions of cCMV in 20 years (31.7-71.4% if 70% of women are effectively vaccinated). Alternatively, hygiene intervention aimed at preventing CMV infection and re-infection of women of reproductive age from young children is expected to reduce cCMV by less than 2%. The effects of large-scale vaccination on CMV prevalence can be substantial, owing to the moderate transmissibility of CMV at the population level. However, as CMV causes lifelong infection, the timescale on which reductions in CMV prevalence are expected is in the order of several decades. Elimination of CMV infection in the long run is only feasible for a vaccine with a long duration of protection and high vaccination coverage. CONCLUSIONS Vaccination is an effective intervention to reduce the birth prevalence of cCMV. Population-level reductions in CMV prevalence can only be achieved on a long timescale. Our results stress the value of vaccinating pregnant women and women of childbearing age and provide support for the development of CMV vaccines and early planning of vaccination scenarios and rollouts.
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Affiliation(s)
- Ganna Rozhnova
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| | - Mirjam E Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Fiona van der Klis
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Debbie van Baarle
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Marjolein Korndewal
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Ann C Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel van Boven
- Center for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Lucas A, Sinha A, Fowler KB, Mladsi D, Barnett C, Samant S, Gibson L. A framework for assessing the lifetime economic burden of congenital cytomegalovirus in the United States. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:21. [PMID: 31592087 PMCID: PMC6775673 DOI: 10.1186/s12962-019-0189-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022] Open
Abstract
Background In the United States (US), congenital cytomegalovirus infection (cCMVi) is a major cause of permanent disabilities and the most common etiology of non-genetic sensorineural hearing loss. Evaluations of prevention strategies will require estimates of the economic implications of cCMVi. We aimed to develop a conceptual framework to characterize the lifetime economic burden of cCMVi in the US and to use that framework to identify data gaps. Methods Direct health care, direct non-health care, indirect, and intangible costs associated with cCMVi were considered. An initial framework was constructed based on a targeted literature review, then validated and refined after consultation with experts. Published costs were identified and used to populate the framework. Data gaps were identified. Results The framework was constructed as a chance tree, categorizing clinical event occurrence to form patient profiles associated with distinct economic trajectories. The distribution and magnitude of costs varied by patient life stage, cCMVi diagnosis, severity of impairment, and developmental delays/disabilities. Published studies could not fully populate the framework. The literature best characterized direct health care costs associated with the birth period. Gaps existed for direct non-health care, indirect, and intangible costs, as well as health care costs associated with adult patients and those severely impaired. Conclusions Data gaps exist concerning the lifetime economic burden of cCMVi in the US. The conceptual framework provides the basis for a research agenda to address these gaps. Understanding the full lifetime economic burden of cCMVi would inform clinicians, researchers, and policymakers, when assessing the value of cCMVi interventions.
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Affiliation(s)
- Aaron Lucas
- 1RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Anushua Sinha
- 2Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ USA
| | - Karen B Fowler
- 3University of Alabama at Birmingham, Birmingham, AL USA
| | - Deirdre Mladsi
- 1RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Christine Barnett
- 1RTI Health Solutions, 3040 Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Salome Samant
- 2Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ USA
| | - Laura Gibson
- 4University of Massachusetts Medical School, Worcester, MA USA
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Korndewal MJ, Weltevrede M, van den Akker-van Marle ME, Oudesluys-Murphy AM, de Melker HE, Vossen ACTM. Healthcare costs attributable to congenital cytomegalovirus infection. Arch Dis Child 2018; 103:452-457. [PMID: 29363491 DOI: 10.1136/archdischild-2017-312805] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Congenital cytomegalovirus infection (cCMV) can cause symptoms at birth as well as long-term impairment. This study estimates cCMV-related healthcare costs in the Netherlands in early childhood. DESIGN, SETTING AND PATIENTS In a nationwide retrospective cohort study, 156 children with cCMV were identified by testing 31 484 neonatal dried blood spots for cCMV. Use of healthcare resources in the first 6 years of life by children with cCMV and a matched cCMV-negative control group were analysed. Mean costs per child were calculated by multiplying healthcare resource use by its reference prices. EXPOSURE Children with cCMV were compared with cCMV-negative children. MAIN OUTCOME MEASURES The average total healthcare costs per child were based on the average costs for hospital admissions and consultations by healthcare providers. RESULTS Mean healthcare costs of children with cCMV (€6113, n=133) were higher than children without cCMV (€3570, n=274), although statistically not significant, with a mean difference of €2544 (95% CI €-451 to €5538). The costs of children with long-term impairment were two times higher in children with cCMV (€17 205) compared with children without cCMV (€8332). CONCLUSIONS Children with cCMV, especially those with long-term impairment and those symptomatic at birth, accrue higher healthcare costs than cCMV-negative children in the first 6 years of life, although this is not statistically significant. This economic impact is of importance in the evaluation of preventive measures against cCMV. TRIAL REGISTRATION NUMBER NTR3582.
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Affiliation(s)
- Marjolein J Korndewal
- Center for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Marlies Weltevrede
- Center for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | | | - Hester E de Melker
- Center for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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N'Diaye DS, Launay O, Picone O, Tsatsaris V, Azria E, Rozenberg F, Schwarzinger M, Yazdanpanah Y. Cost-effectiveness of vaccination against cytomegalovirus (CMV) in adolescent girls to prevent infections in pregnant women living in France. Vaccine 2018; 36:1285-1296. [PMID: 29397227 DOI: 10.1016/j.vaccine.2018.01.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 12/15/2017] [Accepted: 01/16/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND CMV infections are the most frequent congenital infections worldwide. AIM Assess the cost-effectiveness of vaccination strategies of adolescent girls vs. current practice (hygiene counseling) to prevent CMV seroconversions during pregnancy in France. METHOD A Markov decision-tree model simulated overtime the trajectory of a single fictive cohort of 390,000 adolescent women aged 14 years old, living in France. Impact of vaccination was explored until the end of their reproductive live 40 years later. STRATEGIES COMPARED: "S1: No vaccination" (current practice); "S2: Routine vaccination"; "S3: Screening and vaccination of the seronegative". MODEL PARAMETERS Seroconversion rate without vaccination (0.035%/pregnant woman-week); fetal transmission risk (41%). Vaccine vs. no vaccination: a 50% decrease in maternal seroconversions. OUTCOMES Quality-Adjusted Life-Years (QALYs) of the cohort-born babies; discounted costs; Incremental Cost-Effectiveness Ratio (ICER). RESULTS S2 was the most effective strategy (with 35,000 QALYs gained) and the most expensive (€211,533,000); S1 was the least effective and least costly (€75,423,000). ICERs of strategy S3 vs. S1, and S2 vs. S3 were 6,000€/QALY gained (95% uncertainty range [2700-13,300]) and 16,000€/QALY [negative ICER (S3 dominated by S2) - 94,000] gained, respectively; highly cost-effective because ICER < 1∗France's GPD/capita = €30,000. SENSITIVITY ANALYSIS If the seroprevalence was >62% (vs. 20% in the base case), S3 would become the most efficient strategy. CONCLUSION In France, systematic vaccination of adolescent girls was the most efficient strategy to prevent maternal seroconversions. If the population was less than 62% immune, systematic screening and vaccination of susceptibles would become the most cost-effective approach.
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Affiliation(s)
- D S N'Diaye
- INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - O Launay
- Department of Infectious Diseases, CIC Cochin-Pasteur, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; INSERM U 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France; INSERM CIC 1417, Paris, France.
| | - O Picone
- Service de gynécologie obstétrique et médecine de la reproduction, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; EA2493, UFR des sciences de la santé Simone-Veil, UVSQ, 78180 Montigny-le-Bretonneux, France.
| | - V Tsatsaris
- Port Royal Maternity, Department of Gynecology Obstetrics I, Centre Hospitalier Universitaire Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpital de Paris, Paris, France; INSERM, UMR-S 1139, Paris, France; PRES Sorbonne Paris Cité, Université Paris Descartes, Paris, France.
| | - E Azria
- Department of Obstetrics, Groupe Hospitalier Paris Saint Joseph, Paris Descartes University, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
| | - F Rozenberg
- Assistance Publique des Hôpitaux de Paris, Virology, Pathology and Dermatology Departments, Hôpital Cochin, 27, rue du Fbg Saint-Jacques, 75679 Paris cedex 14, France; Université Paris Descartes et Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Virologie, Paris, France; Institut Cochin, Inserm U1016, Université Paris Descartes, 22 rue Méchain, 75014 Paris, France.
| | - M Schwarzinger
- INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
| | - Y Yazdanpanah
- INSERM, IAME, UMR 1137, UFR de Médecine, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Infectious Diseases Department, Bichat-Claude Bernard Hospital, Paris, France.
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Abstract
The development of a cytomegalovirus (CMV) vaccine has become a top priority due to its potential cost-effectiveness and associated public health benefits. However, there are a number of challenges facing vaccine development including the following: (1) CMV has many mechanisms for evading immune responses , and natural immunity is not perfect, (2) the immune correlates for protection are unclear, (3) a narrow range of CMV hosts limits the value of animal models, and (4) the placenta is a specialized organ formed transiently and its immunological status changes with time. In spite of these limitations, several types of CMV vaccine candidate, including live-attenuated, DISC , subunit, DNA, vectored, and peptide vaccines, have been developed or are currently under development. The recognition of the pentameric complex as the major neutralization target and identification of various strategies to block viral immune response evasion mechanisms have opened new avenues to CMV vaccine development. Here, we discuss the immune correlates for protection, the characteristics of the various vaccine candidates and their clinical trials, and the relevant animal models.
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Identification of a Continuous Neutralizing Epitope within UL128 of Human Cytomegalovirus. J Virol 2017; 91:JVI.01857-16. [PMID: 28077639 DOI: 10.1128/jvi.01857-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 01/02/2017] [Indexed: 01/04/2023] Open
Abstract
As human cytomegalovirus (HCMV) is the most common infectious cause of fetal anomalies during pregnancy, development of a vaccine that prevents HCMV infection is considered a global health priority. Although HCMV immune correlates of protection are only poorly defined, neutralizing antibodies (NAb) targeting the envelope pentamer complex (PC) composed of the subunits gH, gL, UL128, UL130, and UL131A are thought to contribute to the prevention of HCMV infection. Here, we describe a continuous target sequence within UL128 that is recognized by a previously isolated potent PC-specific NAb termed 13B5. By using peptide-based scanning procedures, we identified a 13-amino-acid-long target sequence at the UL128 C terminus that binds the 13B5 antibody with an affinity similar to that of the purified PC. In addition, the 13B5 binding site is universally conserved in HCMV, contains a previously described UL128/gL interaction site, and interferes with the 13B5 neutralizing function, indicating that the 13B5 epitope sequence is located within the PC at a site of critical importance for HCMV neutralization. Vaccination of mice with peptides containing the 13B5 target sequence resulted in the robust stimulation of binding antibodies and, in a subset of immunized animals, in the induction of detectable NAb, supporting that the identified 13B5 target sequence constitutes a PC-specific neutralizing epitope. These findings provide evidence for the discovery of a continuous neutralizing epitope within the UL128 subunit of the PC that could be an important target of humoral immune responses that are involved in protection against congenital HCMV infection.IMPORTANCE Neutralizing antibodies (NAb) targeting the human cytomegalovirus (HCMV) envelope pentamer complex (PC) are thought to be important for preventing HCMV transmission from the mother to the fetus, thereby mitigating severe developmental disabilities in newborns. However, the epitope sequences within the PC that are recognized by these potentially protective antibody responses are only poorly defined. Here, we provide evidence for the existence of a highly conserved, continuous, PC-specific epitope sequence that appears to be located within the PC at a subunit interaction site of critical importance for HCMV neutralization. These discoveries provide insights into a continuous PC-specific neutralizing epitope, which could be an important target for a vaccine formulation to interfere with congenital HCMV infection.
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Ran LH, Bao L. [Research advances in breast milk-acquired cytomegalovirus infection in premature infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18. [PMID: 27751206 PMCID: PMC7389540 DOI: 10.7499/j.issn.1008-8830.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Breast milk is considered ideal food for premature infants, but it can also be the main source of cytomegalovirus (CMV) infection in premature infants. CMV infection may cause serious clinical symptoms, such as sepsis-like syndrome, thrombocytopenia, neutropenia, jaundice, hepatitis, and pneumonitis. This article reviews the research advances in symptoms, treatment strategies, prognosis and the prevention of breast milk-acquired CMV infection in premature infants.
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Affiliation(s)
- Li-Hong Ran
- Department of Neonatology, Children's Hospital of Chongqing Medical University, China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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Wang H, Huang C, Dong J, Yao Y, Xie Z, Liu X, Zhang W, Fang F, Chen Z. Complete protection of mice against lethal murine cytomegalovirus challenge by immunization with DNA vaccines encoding envelope glycoprotein complex III antigens gH, gL and gO. PLoS One 2015; 10:e0119964. [PMID: 25803721 PMCID: PMC4372543 DOI: 10.1371/journal.pone.0119964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/18/2015] [Indexed: 01/13/2023] Open
Abstract
Human cytomegalovirus infects the majority of humanity which may lead to severe morbidity and mortality in newborns and immunocompromised adults. Humoral and cellular immunity are critical for controlling CMV infection. HCMV envelope glycoprotein complexes (gC I, II, III) represent major antigenic targets of antiviral immune responses. The gCIII complex is comprised of three glycoproteins, gH, gL, and gO. In the present study, DNA vaccines expressing the murine cytomegalovirus homologs of the gH, gL, and gO proteins were evaluated for protection against lethal MCMV infection in the mouse model. The results demonstrated that gH, gL, or gO single gene immunization could not yet offer good protection, whereas co-vaccination strategy apparently showed effects superior to separate immunization. Twice immunization with gH/gL/gO pDNAs could provide mice complete protection against lethal salivary gland-derived MCMV (SG-MCMV) challenge, while thrice immunization with pgH/pgL, pgH/pgO or pgL/pgO could not provide full protection. Co-vaccination with gH, gL and gO pDNAs elicited robust neutralizing antibody and cellular immune responses. Moreover, full protection was also achieved by simply passive immunization with anti-gH/gL/gO sera. These data demonstrated that gCIII complex antigens had fine immunogenicity and might be a promising candidate for the development of HCMV vaccines.
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Affiliation(s)
- Huadong Wang
- College of Life Science, Hunan Normal University, Changsha, 410081, Hunan, China
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, Hubei, China
| | - Chaoyang Huang
- College of Life Science, Hunan Normal University, Changsha, 410081, Hunan, China
| | - Jinrong Dong
- Shanghai Institute of Biological Products, Shanghai, 200052, China
| | - Yanfeng Yao
- State Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, Hubei, China
| | - Zhenyuan Xie
- Xie Tu Community Medical Service Center, Xuhui District of Shanghai, Shanghai, 200030, China
| | - Xueying Liu
- Shanghai Institute of Biological Products, Shanghai, 200052, China
| | - Wenjie Zhang
- Xinhua Hospital affiliated to Shanghai Jiaotong University of Medicine, Shanghai, 200092, China
| | - Fang Fang
- College of Life Science, Hunan Normal University, Changsha, 410081, Hunan, China
| | - Ze Chen
- College of Life Science, Hunan Normal University, Changsha, 410081, Hunan, China
- Shanghai Institute of Biological Products, Shanghai, 200052, China
- * E-mail:
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Abstract
PURPOSE OF REVIEW The management of infection in pregnancy aims mainly at improving the diagnosis and prognosis of congenital infections. Over 400 publications have dealt with this issue over the last 2 years, taking advantage of progress made not only in the epidemiological knowledge of infections but also neonatal treatment and prenatal diagnosis and interventions. The focus remains largely on viral and parasitic infections, namely cytomegalovirus (CMV) and toxoplasmosis, with the appearance of influenza as part of recent and severe outbreaks. RECENT FINDINGS The prevalence of CMV infection is stable. The prediction of foetal infection from primary maternal infection is becoming more accurate and therapeutic approaches are promising, including the development of a vaccine in the near future. The prevalence of toxoplasmosis is decreasing markedly in Europe weakening the effect of preventive measures and questioning the rationale for screening. In addition, the efficacy of prenatal treatment is still under scrutiny, although no appropriate randomized controlled trial (RCT) has been undertaken. SUMMARY Accurate dating of maternal primary infection is key to prenatal management including foetal and perinatal surveillance and therapy. Heightened prenatal surveillance following influenza infection in early pregnancy is warranted by an apparent increased risk of nonchromosomal congenital malformations in large epidemiological studies, likely as an effect of maternal hyperthermia.
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Patrone M, Carinhas N, Sousa MQ, Peixoto C, Ciferri C, Carfì A, Alves PM. Enhanced expression of full-length human cytomegalovirus fusion protein in non-swelling baculovirus-infected cells with a minimal fed-batch strategy. PLoS One 2014; 9:e90753. [PMID: 24595278 PMCID: PMC3942479 DOI: 10.1371/journal.pone.0090753] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/03/2014] [Indexed: 01/22/2023] Open
Abstract
Human cytomegalovirus congenital infection represents an unmet medical issue and attempts are ongoing to develop an effective vaccine. The virion fusion players of this enveloped virus are the natural targets to achieve this goal and to develop novel anti-viral therapies. The secreted ectodomain of the viral fusion factor glycoprotein B (gB) has been exploited so far as an alternative to the cumbersome expression of the wild type trans-membrane protein. In the soluble form, gB showed encouraging but limited potential as antigen candidate calling for further efforts. Here, the exhaustive evaluation of the Baculovirus/insect cell expression system has been coupled to an orthogonal screening for expression additives to produce full-length gB. In detail, rapamycin was found to prolong gB intracellular accumulation while inhibiting the infection-induced cell swelling. Not obvious to predict, this inhibition did not affect Baculovirus growth, revealing that the virus-induced cell size increase is a dispensable side phenotype. In parallel, a feeding strategy for the limiting nutrient cysteine has been set up which improved gB stability. This multi-modal scheme allowed the production of full-length, mutation-free gB in the milligram scale. The recombinant full-length gB obtained was embedded into a stable mono-dispersed particle substantially larger than the protein trimer itself, according to the reported association of this protein with detergent-resistant lipid domains.
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Affiliation(s)
- Marco Patrone
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
- * E-mail:
| | - Nuno Carinhas
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Marcos Q. Sousa
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Cristina Peixoto
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
| | - Claudio Ciferri
- Novartis Vaccines and Diagnostics, Cambridge, Massachusetts, United States of America
| | - Andrea Carfì
- Novartis Vaccines and Diagnostics, Cambridge, Massachusetts, United States of America
| | - Paula M. Alves
- iBET, Instituto de Biologia Experimental e Tecnológica, Oeiras, Portugal
- Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal
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Schuster K, Henneke P, Huzly D, Speckmann C. Zytomegalievirusinfektionen im ersten Lebensjahr. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-012-2807-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Chiurchiù S, Carducci FC, Rocchi F, Simonetti A, Bonatti G, Salmaso S, Melchiorri D, Pani L, Rossi P. Is HCMV Vaccine an Unmet Need? The State of Art of Vaccine Development. Int J Immunopathol Pharmacol 2013; 26:15-26. [DOI: 10.1177/039463201302600102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Congenital HCMV infection is the most frequent congenital infection, with an incidence of 0.2–2.5% among all live births. About 11% of infected newborns show symptoms at birth, including hepato-splenomegaly, thrombocytopenia, neurologic involvement, hearing impairment and visual deficit. Moreover, 5–25% of the asymptomatic congenital HCMV-infected neonates will develop sequelae over months or even years. The relevant social burden, the economic costs of pre-natal screening, post-natal diagnosis, follow-up and possible therapy, although still limited, are the major factors to be considered. Several types of vaccines have been explored in order to develop an effective and safe HCMV vaccine: live attenuated, subunit, vectored, peptide, DNA, and subviral ones, but none are available for use. This review illustrates the different vaccine types studied to date, focusing on the possible vaccination strategy to be implemented once the HCMV vaccine is available, in terms of target population.
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Affiliation(s)
- S. Chiurchiù
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F.I. Calò Carducci
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - F. Rocchi
- Italian Medicines Agency (AIFA), Rome, Italy
| | - A. Simonetti
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - G. Bonatti
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - S. Salmaso
- National Centre for Epidemiology, Surveillance and Health Promotion of National Institutes of Health, Rome, Italy
| | - D. Melchiorri
- Department of Physiology and Pharmacology, University of Rome “Sapienza”, Rome, Italy
| | - L. Pani
- Italian Medicines Agency (AIFA), Rome, Italy
| | - P. Rossi
- University Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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